MEDICAID IMPACT CONFERENCE Fiscal Year (Post January 13, 2012)

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1 Eliminate Adult Dental Provide savings associated with eliminating this Services service based on FY estimate. 08/01/2012 ($13,913,359) ($19,287,371) ($33,200,730) No State Plan Eliminate Adult Vision and Provide savings associated with eliminating this Hearing Services service based on FY estimate. 08/01/2012 ($7,338,844) ($10,339,003) ($17,677,847) No State Plan Eliminate Adult Podiatry Provide savings associated with eliminating this Services service based on FY estimate. 08/01/2012 ($1,534,607) ($2,105,408) ($3,640,015) No State Plan Eliminate Adult Chiropractic Provide savings associated with eliminating this Services service based on FY estimate. 08/01/2012 ($432,026) ($592,719) ($1,024,745) No State Plan Limit Payment for Podiatry Services to 12 visits per year for Adults Limit Payment for Chiropractic Services to 12 visits per year for Adults Limit Payment for ER Visits to 12 per year for Adults Limit Payment for ER Visits to 6 per year for Adults Limit Payment for IP Days to 23 days for Non- Pregnant Adults Limit Payment for Home Health Visits to 3 visits per recipient per day Limit Payment for Practice Visits to 2 per month Provide an estimate of savings if Podiatry Services were limited to 12 visit per year for adult beneficiaries. Analysis should discuss any federal or state implementation issues with limiting this service and number of beneficiaries impacted. 08/01/2012 ($69,076) ($94,768) ($163,844) No State Plan Provide an estimate of savings if Chiropractic Services were limited to 12 visit per year for adult beneficiaries. Analysis should discuss any federal or state implementation issues with limiting this service and number of beneficiaries impacted. 08/01/2012 ($40,482) ($55,539) ($96,021) No State Plan Provide an estimate of savings if ER visits were limited to 12 visits per year for adult beneficiaries. Analysis should discuss any federal or state implementation issues with limiting this service and number of beneficiaries impacted. 08/01/2012 ($7,416,854) ($10,373,313) ($17,790,167) No State Plan Provide an estimate of savings if ER visits were limited to 6 visits per year for adult beneficiaries. Analysis should discuss any federal or state implementation issues with limiting this service and number of beneficiaries impacted. 08/01/2012 ($21,992,336) ($30,361,058) ($52,353,394) No State Plan Provide an estimate of savings if IP Days were limited to 23 days per year for non-pregnant adult beneficiaries. Analysis should discuss any federal or state implementation issues with limiting this service and number of beneficiaries impacted. 08/01/2012 ($66,603,336) ($148,698,590) ($215,301,926) No State Plan Provide an estimate of savings if Home Health Visits were limited to 3 visits per recipient per day for adult beneficiaries. Analysis should discuss any federal or state implementation issues with limiting this service and number of beneficiaries impacted. 08/01/2012 ($505,795) ($723,988) ($1,229,783) No State Plan Provide an estimate of savings if Practice visits were limited to 2 visits per month for adult beneficiaries. Analysis should discuss any federal or state implementation issues with limiting this service and number of beneficiaries impacted. 08/01/2012 ($1,419,337) ($2,252,131) ($3,671,468) No State Plan 1 of 6

2 Nursing Home/Hospice Rate Hospital Inpatient Rate Hospital Outpatient Rate County Health Department Rate ICF/DD Rate Nursing Home/Hospice rates by 1%. Include impact on Hospice rates. 7/01/2012 ($12,863,224) ($17,567,870) ($30,431,094) No State Plan Hospital Inpatient rates by 1%. Include impact on HMO rates. Provide a mechanism to calculate the rate freeze. 7/01/2012 ($14,928,210) ($34,813,176) ($49,741,386) No State Plan Hospital Inpatient rates by 1%. Include impact on HMO rates. 7/01/2012 ($4,264,048) ($10,015,362) ($14,279,410) No State Plan County Health Department rates by 1%. Include impact on HMO rates. Provide a mechanism to calculate the reduction. 7/01/2012 ($812,050) ($1,118,501) ($1,930,551) No State Plan ICF-DD Provider rates by 1%. Provide a mechanism to calculate the reduction. 10/01/2012 ($1,073,107) ($1,465,590) ($2,538,697) No State Plan Private Duty Nursing Rate Provide an estimate of the savings with a reduction in rates for private duty nursing. 08/01/2012 ($770,559) ($1,052,387) ($1,822,946) No State Plan Physician Services Rate Provide an estimate of the savings 08/01/2012 ($4,934,775) ($6,939,504) ($11,874,279) No State Plan Early Periodic Screening Provide an estimate of the savings of a rate reduction for Children Rate for EPSDT services. 08/01/2012 ($318,610) ($435,928) ($754,538) No State Plan Home Health Rate Provide an estimate of the savings of a rate reduction for home health care services. 08/01/2012 ($143,641) ($196,454) ($340,095) No State Plan Non-Emergency Provide an estimate of the savings for a rate reduction Transportation Rate for non-emergency transportation services. 10/01/2012 ($258,064) ($352,452) ($610,516) No State Plan Lab and X-Ray Services Provide an estimate of the savings of a rate reduction Rate for lab and X-Ray services. 08/01/2012 ($454,177) ($626,380) ($1,080,557) No State Plan Speech Therapy Rate Provide an estimate of the savings of a rate reduction to speech therapy services. 08/01/2012 ($229,659) ($313,705) ($543,364) No State Plan Personal Care Services Provide an estimate of the savings of a rate reduction Rate to personal care services. 08/01/2012 ($173,191) ($247,521) ($420,712) No State Plan Occupational Therapy Rate Provide an estimate of the savings of a rate reduction to occupational therapy services. 08/01/2012 ($146,563) ($200,181) ($346,744) No State Plan Respiratory Therapy Rate Provide an estimate of the savings of a rate reduction to respiratory therapy services. 08/01/2012 ($85,301) ($116,537) ($201,838) No State Plan Physician Assistants Rate Provide an estimate of the savings of a rate reduction to physician assistant services. 08/01/2012 ($48,237) ($66,055) ($114,292) No State Plan Nurse Practitioners Rate Provide an estimate of the savings of a rate reduction to nurse practitioner services. 08/01/2012 ($30,532) ($41,698) ($72,230) No State Plan 2 of 6

3 A 33B 33C 34 35a 35b FHK Rate Freeze Nursing Home Diversion Move 1,000 nursing home eligible clients from CCE for the Elderly to nursing home diversion Payment for Preventable Hospital Errors Disease Management HIV/AIDS Contract Disease Management Hemophilia Contracts Provide an estimate of the savings if FHK capitation rates continue to be frozen at the June 30, 2010 level. Provide a mechanism to calculate the rate freeze. 10/01/2012 ($4,128,226) ($9,942,075) ($14,070,301) No State Plan Provide an estimate of savings associated with increasing nursing home diversion slots by 1,000. Provide a mechanism to calculate the reduction. 7/01/2012 ($6,956,559) ($9,500,879) ($16,457,438) Yes Waiver In conjunction with the Department of Elder Affairs, provide an estimate of the savings from moving 1,000 nursing home and Medicaid eligible clients from the Community Care for the Elderly Program to the nursing home diversion program. 7/01/2012 $7,849,325 $10,720,169 $18,569,494 Yes Waiver Provide an estimate of savings if the telephony pilot project was expanded to include Broward, Escambia, Martin and Palm Beach counties and if the comprehensive care management pilot project was expanded to include private duty nursing and personal care in Miami-Dade, Broward, Orange, and Palm Beach counties. 10/01/2012 ($3,103,803) ($4,585,042) ($7,688,845) No State Plan Expand program statewide for home health visits. Expand program statewide for private duty nursing. Expand program statewide for personal care services. 10/01/2012 $355,723 $220,296 $576,019 No State Plan 10/01/2012 ($3,987,232) ($6,178,114) ($10,165,346) No State Plan 10/01/2012 ($743,783) ($1,371,176) ($2,114,959) No State Plan Provide an estimate of savings by expanding the policy of no longer reimbursing hospitals for preventable errors to the full Medicare policy. 7/1/2012 ($429,376) ($2,302,567) ($2,731,943) No State Plan Provide an estimate of savings if the HIV/AIDS Disease Management Program was eliminated. Include potential impact of cost shifting for those that would be eligible to receive services through other programs. 10/1/2012 ($3,170,250) ($4,329,750) ($7,500,000) Yes Waiver Provide an estimate of savings if the Hemophilia Pharmacy Discount contracts were eliminated. Include potential impact of cost shifting for those that would be eligible to receive services through other programs. 7/1/2012 $6,271,418 $8,625,063 $14,896,481 No State Plan 3 of 6

4 36a 36b 37a 37b 37c 38a 38b 38c a Pharmacy Reimbursement Pharmacy Reimbursement Reduce Nursing Home Bed Hold Days Reduce Nursing Home Bed Hold Days Eliminate Nursing Home Bed Hold Days Reduce ICF-DD Bed Hold Days Reduce ICF-DD Bed Hold Days Eliminate ICF-DD Bed Hold Days Revise FQHC Billing Requirements Revise Rural Clinic Billing Requirements Limit Medically Needy Program to Physician Services Only for Adults and Continue Funding for Children and Pregnant Women Provide the estimated savings from lowering the pharmacy reimbursement methodology to WAC plus 1.0 percent. 7/1/2012 ($3,404,481) ($4,837,849) ($8,242,330) No State Plan Provide the estimated savings from lowering the pharmacy reimbursement methodology to WAC only. 7/1/2012 ($10,369,915) ($24,759,469) No State Plan Savings associate with limiting nursing home bed hold days to four days instead of eight. Analysis should show savings at 90 percent occupancy rates. (figure shown is for 8 to 4 days) 7/1/2012 $2,667,585 $3,643,240 $6,310,825 No State Plan Savings associate with limiting nursing home bed hold days to four days instead of eight. Analysis should show savings at 85 percent occupancy rates. (figure shown is for 8 to 4 days) 7/1/2012 $5,313,124 $7,256,371 $12,569,495 No State Plan Savings associate with eliminating nursing home bed hold days. 7/1/2012 ($5,952,465) ($8,129,544) ($14,082,009) No State Plan Savings associate with limiting ICF-DD bed hold days to four days instead of eight. Analysis should show savings at 90 percent occupancy rates. (figure shown is for limit to 4 days) 7/1/2012 ($33,191) ($45,331) ($78,522) No State Plan Savings associate with limiting ICF-DD bed hold days to four days instead of eight. Analysis should show savings at 85 percent occupancy rates. (figure shown is for limit to 4 days) 7/1/2012 ($5,532) ($7,556) ($13,088) No State Plan Savings associate with eliminating ICF-DD bed hold days. 7/1/2012 ($508,928) ($695,066) ($1,203,994) No State Plan Provide an estimate of the cost to allow more than one billing for service per day in FQHCs. Provide an estimate of the cost to allow more than one billing for service per day in rural clinics. Update AHCA reduction issue 33V6000 from Schedule VIII-B. 10/1/2012 To Be Determined 10/1/2012 To Be Determined To Be Determined To Be Determined State Plan State Plan 4/1/2013 ($361,995,115) ($545,027,014) ($907,022,129) No State Plan 4 of 6

5 Limit Medically Needy Program to Physician, Inpatient, Outpatient and Drugs for Adults and Continue Funding for Children and Pregnant 43b Women 44a 44b a 47b 48 Limitation on Medipass Limitation on Medipass Retract 20% of Dental Provider Increase and allow fee for service Increase Private Duty Nursing Rates Make Kidcare Available to State Employees Make Kidcare Available to State Employees (change in GR match & reduced transfer rate) ICF/DD Assessment Consistent with the Governor's Recommendation Provide an estimate of the savings with the elimination of Medipass in counties with 2 or more managed care plans. Assume current projections of IGT contributions for exempt hospitals and buy-backs are maintained and are used to support capitated health plan payments to hospitals in affected counties. 4/1/2013 ($23,005,825) ($32,124,353) ($55,130,178) No State Plan 11/1/2012 ($31,262,320) ($43,385,569) ($74,647,889) Yes Waiver Provide an estimate of the savings with the elimination of Medipass in counties with 2 or more managed care plans. Assume no IGTs are contributed to support capitated health plan payments to hospitals in affected counties. Change only applied to mandatory populations. 11/1/2012 $64,678,918 ($139,326,807) ($74,647,889) Yes Waiver Provide an estimate of the savings of reducing rate increase provided to pediatric dentistry for FY by 20% and allow fee for service in conjunction with pre-paid dental plans. 10/1/2012 ($4,923,109) ($6,775,206) ($11,698,315) No State Plan Costs associated with paying a blended rate (LPN and RN) for Private Duty Nursing Services based on Fiscal Year Estimate. Analysis should show incremental costs for blended rates of $25.00-$27.50 in $0.50 increments. (figure shown is for the $25.00 blend) 7/01/2012 $1,155,943 $1,578,721 $2,734,664 No State Plan In conjunction with the Department of Management Services, provide an estimate of the savings from allowing state employees to enroll in the Kidcare program. See SB /01/2012 ($626,704) $14,316 ($612,388) No State Plan In conjunction with the Department of Management Services, provide an estimate of the savings from allowing state employees to enroll in the Kidcare program. See SB 510. (Change in GR share from 70% to 66.7% and reduced state employee transfers by 10%) 7/01/2012 ($519,316) $14,564 ($504,752) No State Plan Provide an estimate of revenue generated by requiring an assessment of net revenue to ICF/DD facilities up to the maximum allowable amount of 6%. 7/01/2012 $0 {34,089,319} {34,089,319} No Waiver 5 of 6

6 Nursing Home/Hospice Assessment Increase FHK Rate to Provide an 85% MLR Hospital Emergency Departments Provide an estimate of revenue generated by requiring an assessment of net revenue to Nursing Home/Hospice facilities up to the maximum allowable amount of 6%. 7/01/2012 $0 {973,804,973} {973,804,973} No Waiver Costs associated with increasing FHK Rate to provide an 85% medical loss ratio for FY /01/2012 $5,504,301 $13,256,099 $18,760,400 No State Plan Provide an estimate of savings if payments to hospital emergency departments were adjusted to reimbursement non-emergent care visits using the diagnostic code that corresponds to the type of nonemergent care visit. (Additional Informaiton was sent under a previous ). To Be Determined To Be Determined No State Plan 52 Hospital Rate Banding Update the Governor's Proposal related to hospital rate banding. 7/01/2012 ($388,245,581) ($1,545,455,269) ($1,933,700,850) No State Plan 53 Eliminate Optional Eligibility Category - Medicaid for Aged and Disabled Update AHCA reduction issue 33V6100 from Schedule VIII-B. 10/01/2012 ($11,238,692) ($16,368,104) ($27,606,796) Yes Waiver 6 of 6